Provider Demographics
NPI:1306834155
Name:YARDNEY, MARC JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:JONATHAN
Last Name:YARDNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JON
Other - Middle Name:
Other - Last Name:YARDNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:241 CONESTOGA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3916
Mailing Address - Country:US
Mailing Address - Phone:610-688-3015
Mailing Address - Fax:610-975-0720
Practice Address - Street 1:241 CONESTOGA RD
Practice Address - Street 2:SUITE B
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3916
Practice Address - Country:US
Practice Address - Phone:610-688-3015
Practice Address - Fax:610-975-0720
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027508E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA067802Medicare PIN
B34440Medicare UPIN